There was a considerable confusion concerning the brain areas that contributes to ipsilateral activity during unilateral finger movement. Limited evidence suggested engagement of the ipsilateral dorsal premotor cortex (PMd) more than the ipsilateral primary motor cortex (M1) only in functional magnetic resonance imaging (fMRI). In this study, we aimed to delineate the physiological changes obtained by transcranial magnetic stimulation (TMS) in the ipsilateral M1 during unilateral hand movement by comparing it with the functional magnetic resonance imaging (fMRI) activity obtained from M1 and PMd within the same set of subjects.

Stroke is the third highest cause of death, and the single most important cause of disability in New Zealand (NZ) and other developed countries. Successful rehabilitation via organised stroke care can reduce mortality, the discharge rate to institutional care and the level of dependence for those discharged home. Guidelines for stroke rehabilitation, from NZ and elsewhere recommend ‘organised stroke care’, expert stroke rehabilitation clinicians working in teams, and the use of guidelines for common problems following stroke.

Quality improvement is an important component of hospital stroke care. Implementing guideline recommendations, based on high-quality evidence, should, theoretically, lead to better outcomes. However, inpatient stroke care and rehabilitation is complex. Many factors potentially influence final outcomes. These include resource constraints, such as bed capacity in acute stroke units and overall hospital bed utilisation reflected in pressure to reduce hospital length of stay, decisions about transfer for inpatient rehabilitation or to institutional care, and the availability of well-resourced early supported discharge teams in the community.

Hemiplegic shoulder pain occurs in approximately 25-30% of the post-stroke population, but there is a paucity of evidence- based treatments. Multiple aetiologies can contribute to the development of hemiplegic shoulder pain, including soft tissue injuries, changes in motor control, and central nervous system alterations. Initial loss of motor tone can contribute to instability and subluxation, which in turn can lead to soft tissue or nerve injury, though there is conflicting evidence regarding the role of subluxation in the development of hemiplegic shoulder pain.

A 53-year-old right-handed healthy male health care professional presented with 2.5 months of numbness and tingling in the left median nerve distribution, consistent with carpal tunnel syndrome. Six weeks before symptom onset, his hand use for keyboarding had increased because of the implementation of an electronic health record system and he began wearing a circumferential left-wrist electronic pedometer. The increased repetitive finger flexor motion, altered wrist flexion/extension angle while typing, and mild circumferential compression of the flexor tendons and median nerve likely led to his symptoms. He had no upper extremity clubbing, cyanosis, or edema but had mild bilateral thumb carpometacarpal joint arthritis with minimal osteophytes and slight subluxation.